Winter Solstice!
Occurs today at 17:47 GMT when the North Pole is tilted 23.5 degrees away from the Sun.
This represents the shortest amount of daylight in the Northern hemisphere. From now the days get longer until the Summer Solstice when the North Pole is tilted 23.5 degrees towards the Sun.

Today at The Shard.

A Father's Anger, Health Care Administration and the Philosophy of Science.

It is not unusual for parents of children in 'intensive care' to vent their anger and frustration on staff members. One accepts that people under stress can display the recognised signs of grief; "denial", "bargaining", "anger" and "acceptance". These signs are not confined to the bereaved but can also be manifested in those who grieve for their child's suffering. Thank God that the vast majority of kids on our unit do get better! Our mortality rate is about 4% which compares favourably with comparable units.

Of course, understanably, such statistics cut little ice with parents, for them a death is not a fraction it is the loss of a loved one and that is 100%. Even when seriously ill children recover it should not be inferred that the parents are unscathed psychologically; they still had the fear of loss to contend with. They may also be grieving for the 'loss of innocence' - not their child's neccesarily - but their own! People can have a rather 'Pollyannish' view of life which a visit to PICU rudely contradicts, it isn't surprising then that parents feel a deep sense of anger at society for having sold them a lie - that 'all is for the best in the best of all possible worlds'!

Recently one father had a 'go at me'. He could not comprehend 'how in this day and age' medical science had no clear cut answer to an issue he raised. He was quite angry about it and I listened - I hope with good grace - to his frustrations. Of course I had no answer to his technical question although I could have replied "do you really want to discuss The Philosophy of Science?" I suspected he did not. His frustration arose out of a misconception about science; in his worldview "science" was about concrete facts, settled knowledge which can be looked up in a text book. But the reality is "science" does not deal in such certainties, what Mankind "knows" is only ever provisional - we must constantly re-evaluate our knowledge and revise our practice in the light of new information. Medical science is no exception, especially when one is dealing with complex and dynamic disease processes.

Another naive idea which came to grief was his view, of what I will term, his "entitlement" within the UK's National Health Service. I suppose, again, I could have asked "do you really want to talk about 'Social Policy and Health Administration'?" I suspected he did not. He clearly felt that having paid more than his fair share in taxes he was entitled to more than he felt he was getting. I listened - again I hope with good grace - to his frustrations. The answer I could have given would have been inappropriate; 'however much you have paid in tax it is no where near enough! And I bet at the last election you didn't vote for higher taxation did you?!' The demand for all health care services way outstrips the supply and the electorate needs to wake up to that reality. The government is not some rich uncle who can dig ever deeper into his infinite pockets, it is the tax payer who funds the health service and in a world with 'third party payment' we can always be very generous with other people's money can't we? But we live in a democracy where politicians will promise more and more while the electorate is prepared to pay less and less. This irreconcilable conflict is taken out on the people who have to break the bad news to a naive public that the State cannot always provide what they demand and that is usually the same people who are haplessly trying to make the system work!

Western society has produced a generation with a profound sense of what life owes to them. People feel some sort of entitlement from life which is bolstered by our concepts of 'rights' - as if our 'rights' are absolute and written as immutable laws into the very fabric of the cosmos rather than relative and subject to the vagaries of humanity.

But, of course, I didn't say any of this. This father was grieving, but not for his child, who was ultimately discharged from our unit alive and well - he was grieving for the death of his naive worldview!

The tree is now bare.

WESLEY OWEN & the decline of High Street Christian Book Retailing in the UK.

I can't say that I am entirely surprised by the demise of "Wesley Owen" but I was taken aback by "Borders" recent difficulties.

Each Autumn I visit the centre of Leeds to do some Christmas shopping - even though I moved to London nearly 19 years ago I still think that the shopping is better in my adoptive home town; it has everything from Harvey Nichols to a cheap & cheerful market, and every brand in between all in a pedestrianised area.

When I first moved to Leeds from Bradford to start my nurse training at St James' Hospital in the early 1980's the main Christian book retailer in town was 'Scripture Union' with a shop in King Edward Street in the heart of the retail district. I visited 'SU' almost on a weekly basis and built up a collection of books, some of which have stood the test of time and I still have them on my bookshelf.

'SU' subsequently became purely a publishing company and the shops were taken over by Wesley Owen. In Leeds the shop relocated to the other side of The Headrow (Leeds' equivalent of Oxford St!) and away from the main shopping centre.

Each year I would make a point of going into Wesley Owen and this has become my bellweather on the Christian retail scene for what it is worth. What has struck me quite forcefully in recent times is how little floor space is actually given over to books! There was a very large 'greetings card' section and a large area for music and DVDs, a sizeable space for religious knick-knacks and "art"; easily less than half the shop was for books (maybe 40% max if you include childrens books and sunday school material). They had staples like Bibles and a selection of BST commentaries (fair enough!) but I was confused by the section headings - under "Doctrine & Theology" they had books like 'The Shack'!

Readers of this blog will know that I do not rate 'The Shack' and yet even so I would not argue that this book should not be in a Christian bookshop - I do, however, have a problem with it being in that section of a Christian bookshop! The book I was looking for, John Dickson's "Sneaking Suspicion", an evangelistic book, was ostensibly to be found in the children's area an assistant informed us! Overall the selection of books on offer were, in my opinion, "lightweight" at best.

Some have argued that Christians should get out there and support shops like Wesley Owen because they are a witness to the Gospel on the high street. To which I have to say "how can I support them if they don't sell what I want to buy?"

I buy a lot of Christian books but as I've grown older I tend to buy weightier, thoughtful books and publications I will continue to refer to - not the pop paperbacks on offer at Wesley Owen. The stuff generally on sale will date very quickly and most Evangelicals will rapidly out grow this stuff - or, more worringly, the new believer will become very disillusioned with the brand of Christianity on sale there and will move on to other things entirely as they mature.

I also visited 'Borders' in Leeds the morning that company announced that it was going into liquidation. I loved 'Borders' as a book shop because it offered a wide range of unusual books and it had a great DVD section which included a lot of 'world cinema'. On this visit I noticed that it too was selling more pop books and the cinema section had also shifted down market. No doubt they had good commercial reasons for doing this but can a high street store really compete head to head with the internet and supermarkets? Such stores need to have a unique selling point. Surely it should have tried to retain its niche as an up-market bookstore that was a joy to visit and browse around!

If 'Borders' can't succeed on the high street by shifting down market Wesley Owen stands no chance! Surely the way to go is to become a specialist up-market book shop with a particular niche on the high street? But it seems to me that Wesley Owen has lost its soul.

We couldn't find the book I went in to buy - so the assistant very helpfully gave us the web address of an internet book retailer who did stock it! Need I say more?


Post Script dated 6-Jan-2010.
I gather that some of the Wesley Owen stores have been taken over by an Australian company called Koorang and these stores will continue to trade under the WO brand. Some other stores have been taken over by CLC. There remains a large number of WO shops, as yet, without a buyer including the one in Leeds.

UGANDAN LAW ON HOMOSEXUALITY!

There is a proposal in Uganda to pass a law which would include the ultimate sanction against homosexuals.
From an Evangelical Christian perspective I have never understood the church invoking the methods of the world to make people behave as if they are Christian. Such lobbying, at home and abroad, effectively substitutes law instead of grace, judgment instead of mercy and belies our professed trust in the sovereignty of God. When we use the methods of the world, or approve of them, we are in danger of bringing the Gospel of Jesus Christ into disrepute.
In the final analysis only Christ can change people's hearts and these sorts of Post-Millennialist projects to enculturate non-believers into Christianity leaves me cold.
"Not by might, nor by power but by my Spirit, says the Lord of hosts", Zechariah 4 v6.

The Cherry Tree in our Front Garden has lost nearly all it's leaves.

In Christ alone my hope is found;
he is my light, my strength, my song.
This Cornerstone, this solid Ground,
firm through the fiercest drought and storm.
What heights of love, what depths of peace
when fears are stilled, when strivings cease!
My Comforter, my All in All,
here in the love of Christ I'll stand.
+
In Christ alone - who took on flesh,

fulness of God in helpless babe!

This gift of love and righteousness,

scorned by the ones he came to save,

till on that cross as Jesus died

the wrath of God was satisfied -

for every sin on him was laid:

here in the death of Christ I live.

+

There in the ground his body lay:
Light of the world by darkness slain.
Then bursting forth in glorious day,
up from the grave he rose again!
And as he stands in victory,
sin's curse has lost its grip on me,
for I am his and he is mine -
bought with the precious blood of Christ.
+
No guilt in life, no fear in death;
this is the power of Christ in me;
from life's first cry to final breath
Jesus commands my destiny.
No power of Hell, no scheme of man
can ever pluck me from his hand:
till he returns or calls me home,
here in the power of Christ I'll stand!

Yesterday's developments at The Shard!

"YOU SWEEP THEM AWAY AS WITH A FLOOD; THEY ARE LIKE A DREAM."

Twenty years ago today the Berlin Wall was breached signalling the end of the Communist experiment in Europe. Within a few years the Soviet Union folded up and the world seemed destined for a unipolar future. Some even speculated that with the apparent triumph of Liberal - Capitalist- Democracy history itself had reached some sort of definitive conclusion.

Growing up in the 60's and 70's the mighty USSR seemed to be a monolithic power structure which would certainly outlast me - how wrong I was. As ludicrous as it seems now the Soviet Union and its empire seemed an unassailable fact of life and some of my contemporaries even saw it, on balance, as a force for good!

Psalm 90 seems apt;
"You return man to dust
and say, "Return, o children of man!"
For a thousand years in your sight
are but as yesterday when it is past,
or as a watch in the night."

It would be a bad mistake to put our trust in Mankind - whatever the political or economic ideology. The lesson of history is not the triumph of capitalism or democracy but the fragility of all that Man constructs and the hubris which asserts its ascendancy. Only God is "from everlasting to everlasting" and security is only found in Him! "Lord, you have been our dwelling place in all generations". Amen.

11th November 2009. A Wonderful Addendum!
I would like to add this additional comment: God sweeps aside these pretentions of Mankind - these mighty empires come for a season and wither; they are utterly insignificant to God. But in case we are tempted to feel that our individual lives have even less significance 2 Peter 3v8 relecting on Psalm 90 says this, "with the Lord one day is as a thousand years...." Nothing is insignificant to the Lord - He has all the time in the world for you!

Autumn leaves of our Cherry Tree.

Foundations of the SHARD!

People watching the Shard!

Dan's Favourite Aunt!


Paraphrasing (majorly) Dan Baker (and I appreciate I am taking a major liberty in doing so!) "if the only way you can discredit an assertion is by misrepresenting it then you are conceding that it CAN be taken on its own merits"!

The Voice of "Raven".

One of the most enjoyable things about my excursions to the Lake District is ending a walk with a journey on one of the 'Ullswater Steamers' back to my campsite at Pooley Bridge.

In fact the main reason I base myself at the wrong end of Ullswater rather than in Patterdale is so that I can enjoy the lake. Taking the first bus of the day along side the lake and returning on a 'steamer' (now actually diesel!)

At the end of a hard walk it is wonderful to sit back on the upper deck with a pint and watch the mountains go by - it is magical.

Back in the early 1990s when I first discovered this form of transport even the public safety announcement was wonderful. As soon as "Raven" set off an automated recording would be activated. "Welcome aboard the motor yacht 'Raven'." Sadly this has been replaced by the gruff sound of the captain, but back then it was a female voice with a mid-atlantic accent who spoke in such a mellifluous way - never has "float free buoyancy apparatus" and "self inflating life rafts" sounded so appealing!

For me, her voice will always be associated with "Raven"!

Lake District Adventure.

Most years I try to get away to do some walking in the English Lake District. I usually camp and do a series of walks over a week long period. This year I based myself at "Hillcroft" camp site near Pooley Bridge and used this as my base to do the following walks.

On Sunday 6th September I walked the length of Lake Ullswater from Pooley Bridge to Patterdale and around the south of the lake to Glenridding; I took in Hallin Fell (388m) en route. Ullswater is England's 2nd largest lake at 14.5km.

On Monday 7th I climbed "High Street" (828m) via Pasture Bottom and returned by way of Angle Tarn.

Wednesday 9th I went up "Fairfield" (873m) via St Sunday Crag and returned via Dovedale.

Thursday 10th I climbed up "Helvellyn" (950m/3,117ft) via 'Striding Edge' from Glenridding and returned by way of Nethermost Pike and Dollywaggon Pike and Grisedale.

CHILD PROTECTION!

*

Today was a 'Team Away Day' mainly dedicated to a variety of mandatory training issues. We covered things like 'Infection Control' and 'Pain Control in the Paediatric Intensive Care Unit'.

*

We had a couple of major sessions on 'Child Protection'. One of the most distressing aspects of PICU is coping with the aftermath of a "non accidental injury". Sadly not all the kids make it!

"I'm not 52, I'm 18 with 34 years experience!"

"Striding Edge" in the English Lake District is a narrow ridge on one of the approaches to Helvellyn (950m/3,117ft), it is a tricky traverse and over the years several people have fallen to their deaths.

One noted instance is that of Charles Gough who was killed there in 1805 made famous by the fidelity of his dog which guarded his body until the skeleton was found some months later. The romantic poets wrote that the dog was sustained by "love sublime"............................. are you thinking what I'm thinking?

AMBIGUITY WARNING!
*
While I was away in the Lake District recently I came across this bottle of beer in a shop there and immediately thought of Dawn and what an apt gift to send on to her.
I wasn't sure whether to laugh or cry about the surreal 'spin' she put on the birthday card I'd sent to her. I figured God was saying 'laugh don't cry!' So today I posted this gift to her but I did take the precaution of adding a warning.......and a special offer which I hope she will take me up on. The labels I added read as follows;

*
AMBIGUITY WARNING!


It should not be inferred from this beer bottle label that I have ever participated in or approved of animal cruelty. No conclusion should be drawn from the kilted figure that I am anti-Scottish or racist. or that I condone the Highland Clearances. The gender of the animal is not intended to imply misogyny or indeed prejudice against any other engendered or transgendered sheep. Just enjoy the beer.

*
Pete.
*

ps GENUINE OFFER!
*
Sometime when you are next in London I can give you a tour of where I work and you can get to know a bit more about me.

WHAT KIND OF GOD WOULD ALLOW A THING LIKE THIS TO HAPPEN?

*

*

*

post-script dated 31st August 2009 at 09:10 am.

Dear Dawn,

*

When I included this cartoon in the homemade birthday card I sent to you I was expressing my impish sense of humour and I was not trying to make some wider point.

*

I was not making out that human suffering is a suitable subject for mirth nor was I suggesting that in God's eyes all such suffering is seen as equally trivial.

*

First off; John Callahan is an American cartoonist who is quadriplegic following a car accident. He cannot grasp anything with his fingers and so he draws by holding the pen between his hands. And 'yes' his humour can be dark, which I do indeed quite like.

*

Secondly; the humour here is not aimed at human suffering but is found in the cartoon character's inappropriate sense of moral outrage at God over what the self-regarding cartoon character perceives to be a major existential crisis.

*

I guess some things just aren't funny if you have to explain them!

God Bless,

Pete.

*

*

*

PPS: 3rd September 2009. It has been pointed out to me that the Callahan cartoon suggests that all human suffering is somehow beneficial to the sufferer (it is fair to say that the cartoon character could probably afford to lose a few pounds!). But - in all honesty - it never crossed my mind that that was the main conclusion to draw from either Callahan, or by adoption, the birthday card I made. I do feel that to attribute such sentiments to me on this basis is surreal.

Gym Update.

Ran 2.63Km in 15 minutes on the treadmill. I'm trying to get reasonably fit for my Lake District walking trip in September.

Jubilee Line Blues.............

Last weekend (as usual) some part of the Jubilee underground line was suspended for engineering works which means that I had to take the bus to work instead. From Jamaica Road I caught the 381 to Waterloo and walked the rest of the way to St Thomas' Hospital.

On Sunday the bus journey was dominated by the banter of a small group of youths who permeated the atmosphere with vulgarity and menace.

I prefer the sullen silence of the tube journey!

Richard Dawkins' Summer Camp.

There is a superb cartoon from "Private Eye" about Richard Dawkins' Summer Camp aimed at teaching children the joys of atheism.

A camp leader is counselling one of the children, "I'm sorry Cuthbert but because you came last in the running race.... you must die!"

That 'One Small Step'...

Fot those of us on this side of the Atlantic Neil Armstrong's first step on the Moon came at about 3.30 in the morning of 21st July 1969. As an excited 11 year-old I came downstairs from bed to watch this event on TV.

7/7 Bombings.

Today is the fourth anniversary of the 7/7 Bombings in London in 2005. Three tube trains and a bus were bombed killing over 50 people.
I heard this on the news in the late morning of 7th July 2005 and phoned work saying that I was available if required.... I do have an 'Adult' qualification as well as 'Paediatric' and wondered if the PICU might have to act as an overflow from Adult ITU. I was asked to help cover the night shift - with the transport system closed down it was probably going to be impossible for a lot of our staff to physically get in to work anyway on PICU. I even volunteered to put up people from the day shift in our house if they couldn't get home.
As it turned out the transport system was up and running by evening, and everyone who was due in for work turned up. I wasn't actually needed. I went in anyway.
I never felt so proud to be a Londoner!

GEEZER MAIL!

I seem to have hit that difficult age when I start to receive unsolicited "geezer mail"! Just this morning I received ads for elasticated trousers, walk in baths, an adjustable bed, some sort of back support and a FUNERAL plan!

For crying out loud how old do they think I am?!

ADVANCED PAEDIATRIC LIFE SUPPORT.

I would describe APLS as a medical version of "The Crystal Maze". Imagine being ushered from one room to another with some life threatening scenario being laid out before you using a variety of mannikins and equipment.

Basic resus of infants and children are first covered and assessed. Then we moved on to the critically ill child. We coped with cardiac arrhythmias, shockable and non shockable rhythms, and defibrillation. Convulsing children, asthma, anaphylaxis, DKA and cardiogenic problems. And of course a variety of infective causes. Airway management skills are assessed.

The next day we looked at the critically injured child - head injuries, spinal injuries, penetrating chest and abdo wounds etc etc etc. Practical skills like chest drain insertion, surgical airway, emergency thoracocentisis and IO needle insertion.

The point is one expected to make a thorough assessment of the child, identify the problems and take effective action.

Today we had a final assessed scenario and an exam with an 80% pass mark. Anyway I'm pleased to report that I passed. I won't have to do APLS for another 4 years. Hurrah!

Federal Vision (again!)

I was recently told about the 'blog' belonging to David Anderson called 'More than Words' http://mothwo.blogspot.com/

He seems to share some of the same reservations I have about the whole "Federal Vision" mularkey; his blog might be worth checking out.

ADVANCED PAEDIATRIC LIFE SUPPORT!

I've been away on holiday for a couple of weeks and now I need to knuckle down and work through the APLS manual ready for the course next week at Guy's Hospital in order to renew my APLS certificate.

Jim Swift, killed in action, aged 19.

James Swift was my father's elder brother who died on the Western Front in 1918. When I was a kid the First World War seemed like ancient history to me but the older I get the time difference seems less and less significant.

Last weekend in Leeds I attended my aunt's 100th birthday party. Auntie Anne would have been 8 years old when Jim was killed; it is a remarkable idea that the records I airily pick over represent a real person that Anne knew and grieved for.

The details I have on Jim are sparse but knowing the date of his death and the unit he was with I can place him in the path of the German Spring Offensive of 1918. This was the German's final gamble to win the war outright before the Americans could intervene in force. The offensive is now known as "The Kaiser's Battle" or "Kaiserschlacht". German forces no longer required on the Eastern Front following the military collapse of Russia during the Revolution of 1917 were transferred west and the full force fell on the British front line starting on 21st March. British forces reeled under the blow, the Germans broke through and the army was forced to retreat across ground won at such a high cost in the preceding years. Eventually the British lines held and the German threat was contained.

I gather from the family that Jim had only just got to France when he was killed. This is the record I obtained from the Commonwealth War Graves Commission.

Casualty: Private JAMES SWIFT. 205628
Served With: 7th Bn. Queen's Own Royal (Royal West Kent Regiment)
Died: 28th March 1918
Commemorated: POZIERES MEMORIAL
Somme
France
Panel 58 and 59
Additional Information: Age 19
Son of Patrick and Mary Ann Swift, of 38 Exeter St.,
Bradford, Yorks.
He was born and enlisted in Bradford and formerly served in the Yorkshire and Lancashire Regiment.

Jim has no known grave.

How long is a Piece of String?... ooops Cable?!

At the conclusion of our week of heart surgery we had dinner at an Italian restaurant in Nairobi. Cliff, our 'perfusionist', held a sweep-stake where we all had to make a guess as to how long the cable was from the maintained power socket to the Cardio-Pulmonary Bypass Machine in theatre. We all put a £1 into the pot.

Ivy won! It was 29 metres or 95 feet!

Clifford Longley.


I love listening to radio 4 - unfortunately there are occasional bits of grit in my breakfast that have to be endured like "Thought for the Day" on the "Today" programme. This morning I had that awful sinking feeling as I listened to the contributor.

Clifford Longley is a journalist with a long career commenting on religious affairs so it is more with a sense of depression rather than any other emotion that I say what I am about to say. I barely know where to start in unravelling his confection of platitudes... any way here goes.

The notion that people make ethical decisions based on whether they believe they may be rewarded or punished and that atheists, having no such motive, can actually operate on a higher ethical plane leaves me speechless. This is such a childish notion.

The adult reality is that people make ethical decisions based on the worldview they hold to. If one is a thoughtful Christian one makes Christian decisions. An atheist will make choices consistent with that worldview. If it happens that one is an atheist who follows a none Social-Darwinian ethical process then one does so because one instinctively knows (by God's 'Common Grace'!) that such a course is right even if one finds oneself acting in a logically inconsistent manner. That is hardly operating on a higher plane.

The bishop CL was damning on air I suspect was actually pointing out that our values arise from the worldview we hold to be true. Reading between the lines of CL's garbled account the poor bishop was probably simply affirming a Christ centred worldview (which is his job afterall!) but that obviously went completely over CL's head.

A Christian may act unChristianly/Atheistically. An Atheist may act unAtheistically/Christianly. It all depends on the operating worldview. But this is all beside the point because merit is not earned in God's eyes by what we do. That implies that correct ethical choices put us in God's good books but that is not how it works! We all foul up from time to time - so the adult issue is how now do we get right with God given the reality of our failure? As a Christian I believe in Jesus not in my capacity to make correct ethical choices. A Christian, by definition, is someone who has come to a point of repentance rather than the media caricature of someone who is self-righteous, ie someone who believes that they always make correct choices!

As a Christian I seek to make ethical and personal choices consistent with the world as it actually is; though in my weakness I often feel brow-beaten by media pundits pushing the official line and find myself compromising against my better judgement. And when I do fail my primary concern is not fear of being punished it is the sense I have of not having 'walked worthily of Lord'. Others may make ethical choices on worldviews they are in a better place to explain. I seek to make choices which please the Lord, so reward/punishment are not the primary consideration! The ethical debate lies elsewhere entirely in the nature of reality and truth and relationship with God.

Clifford Longley's piece this morning is merely yet another example of the infantilisation of religious discussion in the country when it is crying out for informed comment and debate.

Return from Africa!

I arrived back from Nairobi a couple of hours ago. In all our "MEAK" team did 17 operations on children with congenital heart defects including some of the more complex procedures yet attempted; Truncus, TGA etc.

Sadly one of our patients died midweek which was a low point for us all. We did have our successes - a baby girl with a huge VSD and failing heart had no clear left lung fields on X-Ray. Not only was her heart huge but she also had a raging chest infection. We did physio on her and suctioned out lots of gluey secretions. This is her X-Ray now - hurrah! we have some air on the left side!

The other highlight was that we did the first ever "Switch" for Transposition of the Great Arteries ever attempted in Kenya.

I'll write more about all of this but right now I'm exhausted after a sixty-five hour week and this will have to suffice for now!

The Kenyatta National Hospital in Nairobi.

During our time in Kenya we are aiming to do three major cardiac operations each day. I was speaking to the manager here this morning who told me that they only have the resources to do two or three a week normally; so in our time here our team could clear 2 or 3 months backlog! Which is quite an amazing thought!

I am also given to understand that we did Kenya's first ever "Switch" for 'Transposition of the Great Arteries".

An Amusing Sign by the road en route to the Kenyatta National Hospital in Nairobi.

A group of us from the PICU will be based there 15th-24th May 2009 as part of a team doing open heart surgery.

Nairobi sunset.

Crack PICU team,

Nairobi May 2008.

Claire Barker, Fiona Lynch, Natalie Robertson & Tim James

(I'm behind the camera!)

Peritoneal Dialysis.

During our 2008 trip to Nairobi on a Cardiac Surgery mission one of our post op children went into acute renal failure. I improvised a PD set, as well as made our own bicarbonate dialysis fluid. The advantage of taking a dinosaur like me along is that I remember how we used to have to do things twenty+ years ago!

Take a one litre bag of sterile 0.9% Saline for IV use and remove 350ml using an aseptic technique. Discard this 350ml.

Using an aseptic technique add the following to the remaining 650ml bag of 0.9% Saline; 300ml Glucose 5%, 10ml Glucose 50% and 40ml Sodium Bicarbonate.

Properties of this solution are as follows Sodium 140mmol/L, Glucose 2% and Bicarbonate 40%. PLEASE NOTE THIS SOLUTION CONTAINS NO POTASSIUM! Normally one would add 4mmol/L of Potassium Chloride depending on the patient's serum K+ level; however if the patient is hyperkalaemic use a reduced amount, eg if their potassium level is 5-7 add just 2mmol/L, and if the patient's level is >7 add no potassium to the solution.

Start with Fill Volumes of 10ml/kg. In over 5 minutes, dwell 10 min and drain over 15 min. And repeat the cycle. This will draw off some excess water as well as correct the patient's electrolytes and acidosis. Monitor patient's fluid balance and serum electrolytes regularly until the patient's kidneys recover. Until they do recover restrict the patient's fluid intake to 2ml/kg/hour if they weigh less than 10kg, and if they are upto 20kg give 1ml/kg/hour.

For larger patients give a maximum of 40ml/hr if they weigh more than 20kg (please note this is NOT 40ml/kg/hr but 40ml total volume per hour!)

Facebook.
I recently joined the Facebook crowd........................ so if you can't get enough of me here you can always look me up there!

(ps Gym today: ran 3.52 Km in 20 mins, weigh 91.0 Kg.)

More Training.


Today I completed my annual "Moving & Handling" mandatory training. And, as a special treat, we had a short session on the respirators we are being fitted with in case of pandemic Swine Flu. 3M Respirator type 7500 with p3 filters........................... so I'm okay!.........................

The Age of Aquarius!

Among the wide range of gadgets we use in PICU to help support the sick kids we have is this one. It is an "Aquarius" haemofilter produced by 'Edwards Lifesciences Services GMBH'. We use this for Continuous Venous Venous Haemofiltration (CVVH). We generally use this when the children are in acute renal failure and need excess fluid removing &/or their chemistry correcting. Occasionally we will have children who need a drug dialysing out.

In essence we draw blood out from the patient through a large intra-vascular catheter called a 'vascath' by means of the "blood pump" which is the red roller pump [top left]. The patient's blood is pre-diluted with a dialysis solution [Multi-Bic] drawn from a reservoir bag slung beneath the machine by the green pumps before entering the blood filter in the centre of the picture. Excess water is drawn out from the filter by the yellow pump into a waste bag also underneath the machine (not shown). The filter will also correct the patient's blood chemistry and pull out any other waste products too.

Depending on the size of the patient (and they can be infants all the way up to teenagers!) we will select the appropriate size filter and the various parameters for an effective treatment. This is programmed into the computer screen at the top of this picture.

Renal Replacement Therapies is one of my 'specialities'.

Covenantal Objectivity.


If someone died on the way to their baptismal service do you believe that that would be "objective" evidence that they were not saved?

Return to Africa.

This coming May I will be returning to Nairobi with a team of people to do open heart surgery on children there. This will be my third such trip having been before in 2007 and 2008.

My role will be to help set up an improvised Paediatric Intensive Care Unit on ward 4b in the Kenyatta National Hospital and to care for children following their heart operation.

The picture above was of first impressions taken by me in 2007 when we very first arrived on the unit we were to use. The electric bar fire was an improvised attempt at an incubator! The hurricane lamp was the emergency lighting. The ventilators were pretty good though. The monitors were clunky old Hewlett Packard monitors which I recall using twenty years ago - they're outdated but effective. Lab facilities were pretty minimal so we had to rely on our own clinical judgment a lot. It was a real privilege to be part of this whole enterprise organised by MEAK (Medical & Educational Aid to Kenya).

During our time there we did over twenty operations. My proudest moment came last year when I improvised a means of giving peritoneal dialysis to one of our patients with my own homemade brew of dialysis fluid! He was very ill and went into acute renal failure. The advantage of taking a dinosaur like me along is that I remember how we used to have to do things here 15-20 years ago.

We fly out on 15th May and return on 24th. If I can I'll try and post a couple of blogs describing our adventure there - but the photos might have to wait until I'm back in the UK!

Jars of Clay! Just Jars of Clay!

Last night at St Helen's we had our 'Annual Parochial Church Meeting' at which William Taylor and a number of others laid out the vision for the church over the next ten years. The venue is pretty sizeable but even so it was packed out!

The numbers on the electoral roll at St Helen's are currently 895 people - although I am sure that many more actually attend our range of services. This makes us one of the largest churches in London despite having lost a significant number of people in recent years to our various church plants around the city. We have a thriving Mandarin speaking congregation and on-going work among other communities within London. St Helen's continues to support work in the French speaking world and Sub-Saharan Africa. But William was very clear to emphasise that the continuing growth of the ministry here is not down to our abilities. It is the power of God's Word alone - it has to be - because we are just jars of clay! It is in our very weakness that God's power can shine through.

By God's grace our vision is to see 20 gospel hearted churches planted by 2020. We also want to develop a French speaking congregation from among the many such people based in London.

There is also a plan to beef up our 'Digital' ministry. The whole internet social networking thing is a vast new area we need to grow into. Our web page gives the impression that St Helen's is all about programmes rather than people and we hope to redress that perception by drawing on the individual stories of the people within our church family. So watch this space!

After the public business was wound up there was a brief meeting of the PCC - the Parochial Church Council - of which I am now formally a member. It is a real privilege to be part of this 20-30 strong group especially with such a fantastic strategy in place. It is comforting to be reminded that it is in our weakness that God's power will be demonstrated - I am very conscious of my own inadequacy, but I'm sure I'm not alone. Jars of Clay! Just Jars of Clay!

Latest on the Gym front!

Today I had a good run; 3.45km in 20 min! I also did some 'core' muscle exercises to help my back.

I would like to get to a point where I can run 10 kilometres comfortably again.

Cherry Blossom Snow.

Our lovely cherry blossom tree has slowly shed its petals.

Floating pink blossom gently fluttering down like snow on a warm spring breeze.

Daniel for Adults!

Today William Taylor continued his new series of talks on the book of Daniel. Last week we looked at chapter one and this Sunday we covered chapter two. What I find enormously encouraging is how faithful God is to his promises. Great empires come and go, nations rise and fall but God remains constant and those who put their trust in him are secure.

The great statue which depicted a whole sequence of mighty empires is ultimately overwhelmed by a rock not cut by human hand and the remnants of these empires are blown away like so much chaff in the breeze.
Where is babylon now? In a room belonging to the British Museum! In my own life time an empire like the Soviet Union - which seemed such a monolithic power at the time - vanished overnight. The recent financial crisis is a warning to us that God doesn't owe the west anything either. The veneer of civilisation we naively think is so secure is anything but. All such confidence is vanity.

Thank God that he stays true to his promises though. Are you going to build on the rock or on something else?

C.S. Lewis "The Most Reluctant Convert".

After paying an extended visit to "the dark side" with my recent readings about Stalin's Russia it has been a real JOY to read something which refreshes my soul.

David C Downing's biographical account of CS Lewis's journey to faith has been a real encouragement, not just because it's a great story but because there are nuggets of spiritual insight that resonate with any believer.

I was particularly struck by Lewis's struggle with self analysis - something most sensitive people are troubled by. Lewis's initial loss of faith arose when he realised that he was not being "sincere". Later (p132) he came to the realisation that one cannot "enjoy" and "contemplate" at the same time. You cannot be both unselfconscious and selfconscious simultaneously. To contemplate one's sincerity at prayer (for example) is not to be praying. Consequently such self analysis becomes self defeating. The key seems to be to enjoy the moment and not over-think your own personal significance within it. Lewis calls this 'fussy self attentiveness'. That is an absolutely brilliant insight! I say this as someone often guilty of the same pointless introspection!

I've always been impressed by Lewis's attack on "chronological snobbery"; the conceit that one's own era is superior for no better reason than it comes later. This is the arrogance that fed the Modernist totalitarianism that Lewis confronted in the mid 20th century. Perhaps it will take 50 years for our present day 'chronological snobs' to be unmasked and people then will stand aghast at how our generation was taken in by our own ideologues! The lesson of history is clear; when we abolish God we find we also abolish Man!

Prior to his conversion Lewis had written a couple of obscure books of poetry. His faith in Christ fired up his creativity. He became a prolific writer of the most diverse range of subjects; apologetics, children's stories, science fiction etc. People will still be reading Lewis when the Pullmans of this age are long forgotten. Of course these others will have a momentary notoriety but the things that last touch us with truths that transcend the momentary and remind us of our deeper humanity.

This is the lovely Helen working on her water colours. Today is our 14th Wedding Anniversary.

The caption on the 'Matt' cartoon about today's Budget speech......

"How is it possible to be both alarmed AND bored at the same time?!"

RCN Consultation on

Assisted Suicide.

The Royal College of Nursing in the UK is presently carrying out a consultation among it members to see what the consensus of professional opinion is about 'assisted suicide'. So if you are a member and have an opinion on this topic you have until 22 May 2009 to send your views into the RCN.

One of the worrying aspects of this so-called "debate" is how the pro-euthanasia lobby frequently misrepresent the issues in the media and not infrequently caricature people who object to euthanasia as motivated by ill-will or sheer ignorance.

For example; the case is often put forward that it is accepted 'custom & practice' for patients to die in pain and that they are subjected to unwanted medical interventions. These commonly accepted fallacies are repeated so often and so authoritatively that the innocent public are unduly influenced by them. It is no surprise that public opinion is moving towards euthanasia but the fact is they are faced with the phoney "false choice" argument ie 'do you want your loved ones to die in agony, yes or no?' Who in their right minds would say anything but 'no!' given that proposition?

I have worked in children's and adult's critical care for more years than I care to remember and I can honestly say that I do not recognise the caricature of our profession.

First up, it is NOT acceptable practice for patients to be in pain - that is not acceptable and there is no excuse for it. If the disease process is such that pain control foreshortens life then so be it - that is not euthanasia or assisted suicide - that is effective pain management. This is exactly the same legal situation as someone dying as a consequence of any other medical treatment aimed at controlling the disease process.

Secondly, everyone has a right to refuse medical treatment. All interventions require informed consent. No one has any intervention "forced" on them - indeed to do so is a criminal offence! (There are some legal exceptions of course - when the mental capacity of the patient may be in doubt - in which case there are legal procedures to be followed). In my experience it is more often the case that family members insist on medical interventions when the professional consensus is that further treatment is futile.

Thirdly, the withdrawal of treatment is not euthanasia or assisted suicide. The purpose of medical treatment is to enable the patient to make a recovery. If the consensus of opinion is that no such recovery is possible then active treatment may be withdrawn and the disease process allowed to take its course.

None of the above are the cause of any ethical or professional dilemma! Okay? Clearly the truth does not suit the pro-euthanasia lobby's arguments which is why they resort to caricature.

When the pro-euthanasia lobby stress the 'pain' people are suffering we must of course exclude physical pain because that can and should be adequately treated. I suspect the 'pain' they refer to is existential pain - the pain we will all have to face at some time in our lives as human beings living in a fractured world. How far do you really want to push the limits of state sanctioned suicide as a cure for this? It is no surprise to me to hear that people who are physically healthy but feeling depressed are being offered suicide at a Swiss clinic. Given everything I have said above about the reality of pain control and informed consent and withdrawal of treatment I do not see where the pro-euthanasia lobby is attempting to take society except down the same route.

Oh! And no I am not motivated by ill-will!!!

ps there is a video about this RCN consultation at http://www.policyreview.tv/embed239/882

Our Cherry Blossom Tree!

Lesbian Vampire Killers!

So the Lesbian Vampire Killers aren't lesbian after all.

They're Lesbian-Vampire Killers.

That clears up a lot of confusion here.

Thought for the Day.

Giles Fraser, the vicar of Putney in London, was giving this morning's "Thought for the Day" on BBC radio 4's "Today" programme. He took issue with those Christians who emphasise the significance of the Cross. He said that such an emphasis "left the resurrection 'with nothing to do'!" It seems rather self evident to me that you cannot have the resurrection without first having the cross and actually, when you think about it, the cross gives profound meaning and significance to the resurrection.

But Giles clearly has an issue with the Cross as "all about violence and retribution". In a way, that is not unusual, many people (such as Steve Chalke etc) find the atonement concept outrageous. They will say that it is fundamentally unjust but I think what they actually baulk at is the neccesity of the Cross. Human nature is not so bad that any atonement is neccesary; which is a Humanist worldview rather a Christian one.

For Giles the Cross is an example of Christ sharing in humanity's suffering... please do not misuderstand me, that is perfectly true and I am not denying it, but while it is the truth and nothing but the truth it is not the whole truth. Jesus himself said that his death would have a much richer, far deeper meaning than that, the Cross is not a later theological construct as some allege.

The thing is what really struck me was that Giles sounded so angry about it all - there was some venom in his delivery that astonished me. But perhaps I shouldn't be surprised because he was in the unfortunate position of proposing a poorer and shallower theology than the one he was attacking. Or maybe he was deliberately trying to be provocative.

No doubt some of my fellow Evangelicals might be considering penning a robust counter-attack. I hope that they will do so graciously in a way that will speak to him rather than merely confirm his preconceived ideas. We need to respond with grace if we are to defend the Gospel of Grace.

I notice that Giles Fraser also had a column in the Guardian newspaper on Saturday attacking the Cross in pretty much the same terms as Steve Chalke did a few years back when he described it as "cosmic child abuse". (Incidentally the media seems to have given a fair wind to this particular theological stance hasn't it?) Obviously it is difficult to gauge the tone of a written piece but, again, Giles does seem to be a very angry man.


The fact that an innocent party is punished in my place IS unfair and unjust. But this is an act done in the context of Trinitarian Christianity (it will make no sense outside such a worldview!) God willingly takes on HIMSELF the punishment rightly due to me. That is indeed unjust, but God is a God of Grace.... and grace is not about getting what I deserve - quite the contrary! Not only do I not receive what I do deserve, but I also receive what I do not deserve in exchange (the righteousness of Jesus himself!) and I have all the privileges that come with it. [God's Riches At Christ's Expense!]

One day we will all face God; are you going to front up to him and demand justice? Or like me you may not have such confidence in your own righteousness in which case you, like me, will not be asking for justice but asking for mercy and grace!

Blooming Blossom.

Good Friday is the Best of Days!

I went to the Good Friday service at St Helen's this morning. There was a short talk by Mark O'Donaghue who described Good Friday as the best of days. Of all the days marked in the Christian calendar today's is not one the world has sought to commercialise like Christmas or even Easter and yet for the Christian it is a day commemorating something amazing.... the day Jesus made 'the Great Exchange'. Jesus willingly took on himself the punishment due to me and in exchange I was given his sinless standing before God!

During the service we had a series of readings and hymns and a solo all of which were very moving.

In the eyes of the world the Cross represented the most ignominious of deaths and yet, as is always the case with the Gospel, appearances can be deceptive. As Jesus dies the curtain in the temple is torn in two - the barrier that ceremonially separated a holy God from a less than holy people is split apart. The centurion, a representative of all of us who are foreigners to the things of God, perceives something astonishing in this death "Surely this man was the Son of God!"

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

ps

12th April 2009. Easter Sunday, the very best of days!

Check out the St Helen's Easter Films at www.st-helens.org.uk/easter/

Russia.

I've always been intrigued by the history of Russia having recently read books about Catherine the Great & Prince Potemkin and Robert Service's "History of Modern Russia".

Latterly I have completed "The Whisperers" by Orlando Figes and "Absolute War" by Chris Bellamy.

For whatever reason I have been fascinated by the war on the Eastern Front between Nazi Germany and the Soviet Union during the second world war. (Of course from the Russian perspective it was the Western Front!) The sheer scale of the conflict and its ideological nature between two equally odious totalitarian regimes makes it utterly unique in modern history. "Absolute War" as a title reflects the total nature of this staggering theatre of war; it was a battle to the death of two peoples, two giant economies and two ideologies on a scale never before witnessed.

A quarter of the entire Russian people (as opposed to the other Soviet peoples) are said to have perished in the war so it is not surprising that "The Great Patriotic War", as the Russians call the 1941-45 conflict, still casts a huge shadow over the Russian psyche and probably explains why the Russians are still very sensitive about national security. This scale of casualties of young men caused a major demographic shift; in some towns women outnumbered men by two to one and in some places it was as much as three to one! This altered demography was such that it would not correct itself within one generation but would take several.

The war on the Eastern Front has been well documented from the German perspective but it is only in recent years that the old Soviet archives have been opened up and their contents studied in depth. This has turned up some surprises such as the fact that the Soviet generals detested each other with a passion! There are intriguing hints that the Russians were preparing for a surprise attack on the Germans in 1942 had they not been beaten to the punch! "Absolute War" also casts doubt on certain commonly held fallacies; I had always thought that the Battle of Kursk in 1943 was the largest tank battle in history but according to Bellamy it was no larger than other encounters and was much more ambiguous in its outcome - it sounds like the protagonists traded blow for blow, but maybe the important point is the Russians could afford the losses where the Germans couldn't. Certainly the Germans perceived the battle as a defeat and perhaps that is what really counts.

In Alan Clark's "Barbarossa" there is a fascinating account of the 'sniper duel' in Stalingrad between Vasily Zaitsev and a German officer sent to eliminate the Russian ace - this was the storyline of the movie "Enemy at the Gates" - interestingy Bellamy could find no evidence of such a duel ever having taken place. Also there is no evidence for the suggestion put about by Beria that Stalin had a nervous breakdown when the Germans invaded in 1941. Speaking, please note, after Stalin's death in 1953 Beria said that the dictator was reduced to a catatonic state by events but Bellamy demonstrates that Stalin actually worked tirelessly throughout those initial calamitous days and indeed made some ultimately war winning strategic decisions, such as evacuating the industrial economy beyond the Urals and away from German interdiction. Stalin may have been many things but he wasn't stupid or indecisive.

An interesting question is 'why did the Russian people fight so hard for Stalin?' The reality is they didn't. The Nazis regarded the Slav people as 'untermensch' who were to be eradicated or enslaved; whatever illusions the Russian people might have had of the German army as liberators from the Stalinist regime were quickly dispelled as the Nazis imposed their brutal rule. The "absolute" nature of this war became self evident. It is also a curious fact that even the Gulag prisoners felt that they had a stake in the war-effort and believed that they had a valuable contribution to make toward their Motherland's ultimate victory. Prisoners released to fight on the front line would find, paradoxically, a sense of personal freedom and liberation even in the fiercest fighting. At least here people could be their true selves and didn't have to lead a double life as they might have to in civilian life sloganising in public but being someone else in their private thoughts.

The book is a great stonking read marred in places by some ghastly typos; instead of "lend-lease" there are several lease-lends and even lease-lands! There is also at least one reference to the Soviet Black Sea Fleet which logically ought to read Arctic Fleet. Despite these defects it is well worth a read.

"The Whisperers" is about private life in Stanlinist Russia when there was a concerted effort by the state to eliminate the notion of the personal and substitute the communal as a basis to society. To that end communal apartments were created with shared facilities and family life discouraged by means of quickie divorce. Children were to be raised by the state rather than being "indulged" by families into "bourgeois" thinking that they are uniquely loved, thus causing them to become "egoists". The window this book gives on a gigantic social experiment is breathtaking and has a lot to tell us about our own age as it too engages in a massive social experiment which jettisons the family and society atomises rather than becomes more cohesive.

Where "Absolute War" looks at the big scale "Whisperers" looks at individual stories and is heart rending in its ability to communicate the sense of personal loss as the Messianic state machine arrests and deports to the Gulags innocent, uncomprehending people. School children raised by the system to idolise Stalin and who find role models in the likes of Pavlik Morozov (who betrayed his own father to the state) become obsessed with denouncing 'class enemies' and fuel the paranoia indulged in by Stalin. Wholesale arrests and deportations on a quota basis crush individuals and ruin lives but this human sacrifice serves the Stalinist 'Five Year Plans' by providing slave labour for a crash programme of industrialisation. The enterprising peasant culture is overthrown in favour of farm collectivisation.... resulting in famine. I believe that Christianity gives value to the individual but given the collective mentality of the Soviet state the highest 'good' was that the state was served; all other considerations were secondary at best and more likely to be considered suspiciously deviant. Individual justice was 'bourgeois' and outdated in this Modern Age and a failure in food production could only ever be explained in terms of 'sabotage' - the state's farm collectivisation policy could not possibly be wrong by definition. Enterprising, prosperous peasants were denounced as 'Kulaks' (tight-fisted) and were persecuted - thus driving the 'work ethic' out of Russia's agricultural system. Even Kulak parents might consider their own values as outdated and would abdicate responsibility for their children to the state in a vain attempt to help protect them, but the collective presupposition was such that relatives, including the children, of 'enemies of the people' were just as guilty by association. These children would attempt to conceal their tainted biographies and become model Soviet citizens ever fearful of being unmasked. Whole people groups - Volga Germans, Chechens, Crimean Tartars etc - could be condemned in toto.

The persecution is not confined to the countryside, any problem (real or supposed) within the new industries is rationalised as sabotage by 'enemies of the people'. The most pathetic tales are those of die-hard Communists who find themselves denounced and yet who connive in their own downfall as a way of still yet serving the state! One daughter despairs of her Communist father who is released from the Gulag after many years and who still thinks that the system is just, "you can't talk to a believer!" she says.

The title of the book "The Whisperers", refers to the privately spoken thoughts of everday people in Stalin's Russia and refers not just to the victims point of view but also the many people who make whispered accusations to the secret police. Most of these remain unrepentant to this day and are still convinced that those they caused to be arrested, tortured, imprisoned or shot were indeed 'enemies of the people'. (How else can they live with themselves one might ask!). The police state provided ample opportunity to cause the removal of the irkesome neighbour, a love rival or the occupant of a job one coverted. The system either crushed you or corrupted you. Many individuals brutalised by years and years spent in the Gulag system find that they cannot make the transition back into normal family life again. Yet some relationships prove more resilient. "The Whisperers" is a haunting, heart rending read but well worth it.

In case anyone is under the illusion that Stalin deviated from a gentler version of socialism which might have prospered had Lenin not died in 1924 (only seven years after the Russian Revolution) please refer to Robert Gellately's "Lenin, Stalin & Hitler: Age of Social Catastrophe"! Stalin merely built on Lenin's legacy, he didn't pervert it.

A sensitive man like the poet Konstantin Simonov, who wrote the famous poem "Wait for Me", has a dubiously upper class pedigree and so remodels himself as a proletarian by putting himself through a 'factory school' and consciously suppresses any reservations he has about the regime. Perceived injustices are dismissed as mere bourgeois sentiment; as such he makes an interesting case study of how a sensitive man turns himself into a thorough-going Stalinist. You might think that this may have little to tell us - but from a Christian perspective it is all very familiar Romans chapter 1 territory, how people suppress the truth and are destroyed by what they idolise. It is telling that those individuals who do retain their humanity are those who have an alternative mental framework from which they can draw moral values critical of the all pervasive Messianic state ideology. Only those who had a moral compass of their own could avoid being sucked into the accepted values of their dominant society. Tellingly the odious phrase 'you can't make omelettes without breaking eggs' is a constant refrain of those state functionaries who try to rationalise their own part in wholesale injustice.

It is interesting that Simonov appears in both these books; during the "Absolute War" he was a correspondent reporting directly from the front-line. As the Red Army crosses the eastern borders of the Third Reich Simonov joins in the call for vengence to be visited on the German people in the form of murder, rape and pillage: events described in Antony Beevor's book "Berlin: the downfall 1945" as the German 'holocaust'. Please note these events were not spontaneous acts by unruly soldiers, this was a 'top down' directive promulgated as a patriotic duty! Simonov has misgivings about the vengence policy but again rationalises and suppresses these reservations as bourgeois sentiment and writes the neccesary articles for the army newspaper. As a Christian both these books describe a reality which chimes with the Christian worldview. "Evil" is not perpetrated by in-human 'monsters'': evil turns out to be a very human trait indeed. (I would argue that the word "inhuman" is the most mendacious word in the English language!). Current liberal conceptions of "evil" fall drastically short of the mark; for the present day Humanists all evil has to be 'other' than human! (If only it were that simple!) Yes, we do have our own ideologues don't we? People who try and make reality fit their worldview and "otherise" evil as something remote from themselves.

Perhaps the ghastly nature of Stalinism seems obvious now but in the mid 20th Century many Western intellectuals and trend setters looked on the Stalinist state with profound admiration and saw in it the way of the future. The horrific realities of life within the Soviet state were dismissed by gullible onlookers as western propaganda. In my own lifetime, after the "Khrushchev Thaw" was replaced by Leonid Brezhnev's reassertion of Stalinist principles, and when the Soviet state once seemed a permanent feature on the world stage, I heard many people speak out in defence of the USSR as a force for good. Lenin described such people as "useful idiots". Humans have a capacity for self delusion and our cultural elite are certainly no exception. Given that humans look to themselves for salvation there is no reason - no reason at all - why history should not repeat itself!